Benefits Overview OPEN ENROLLMENT APRIL 23 RD MAY 4 TH
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1 Benefits Overview OPEN ENROLLMENT APRIL 23 RD MAY 4 TH 1
2 What s Changing No increase in Medical Rates for 2019 plan year PT And ACA benefit plan offering changing Penn Faculty Practice Plan (Penn Dental) o now know as Penn Family plan o new location in Berwyn, PA in June 2018 Now 9 Penn Medicine pharmacies where you can obtain specialty medications Enhanced Fertility benefits 2
3 Flexible Spending Accounts New IRS calendar year limit for the Health Care FSA is $2650. Dependent Care FSA limit remains at $5000, Highly Compensated employees limit remains at $1800. Part-Time Healthcare Benefits Effective July 1, 2018, current part-time faculty and staff are eligible to enroll in the Aetna POS II Standard plan. The plan has in-network or out of network coverage. The individual deductible is $900 and the family deductible is $1800. It is important to note that the cost of single coverage is partially subsidized by the University. Penn Care Connects University of Pennsylvania employees now have easy access to new patient appointment scheduling through a concierge line. Find a Penn Primary Care Physician closer to work or home. Appointments are available within two weeks. Call
4 Health Plan Options for Aetna HDHP with HSA Penn will contribute $1,000 for single coverage or $2,000 for family coverage to your HSAHSA Aetna Choice POS II Premium PennCare PPO Keystone/ AmeriHealth HMO 4
5 Active Medical Plan Design Effective 7/1/2018 PennCare PPO Key features 1 Aetna Choice Penn Providers Personal Choice POS II Premium Keystone/ AmeriHealth HMO Aetna HDHP Deductible (Single/Family) 2 $150/$450 $350/$1,050 $300/$900 $100/$200 $1,500/$3,000 HSA Seed (Single/Family) N/A N/A N/A N/A $1,000/$/$2,000 OOPM Overall (Single/Family) $1,000/$3,000 $2,500/$7,200 $1,200/$3,600 $1,200/$2,400 $3,000/$6,000 Primary/Specialist $20/$40 copay $25/$50 copay $30/$50copay $25/$45copay 90%/90% Coinsurance (after deductible) 10% 20% 20% 10% 10% after ded. Lab/Pathology $25 copay $25 copay $30 copay $25 copay 10% after ded. Retail Clinic Copay n/a $25 copay $30 copay $25 copay 10% after ded. Spinal Manipulation (60 visits per year) n/a $50 copay $50copay $45 copay 10% after ded. X-rays/radiology 10% after ded 20% after ded $50(routine) $100 (complex) $40 (routine) $100 (complex) 10% after deductible Behavioral Health Provider PBH PBH PBH Magellan Aetna International Coverage n/a Tier 3 coverage Emergency Care Emergency Care Emergency Care Other Coverage IVF (2 cycles per lifetime/per family and only at HUP) IVF (2 cycles per lifetime/per family and only at HUP) IVF (2 cycles per lifetime/per family and only at HUP) SRS IVF (2 cycles per lifetime/per family and only at HUP) IVF (2 cycles per lifetime/per family and only at HUP) Emergency Room $100 copay $100 copay $150 copay $150 copay 10% after ded Retail Prescription Drugs * Rx Coverage for Local 54 and 590 are separate from Penn Medical Plan Annual OOPM: $2,000/$6,000 (Individual/Family) 10% after deductible applied to medical OOP Max 5
6 Prescription- CVS/Caremark Applies to those enrolled in the PennCare/Personal Choice PPO, Aetna Choice POS II, and Keystone/AmeriHealth HMO plans Generics Brand Names with No Generic Equivalent Brand Names with Generic Equivalent* Specialty Coinsurance; Minimum and Maximum Payment Non-Maintenance 30-day supply (any network retail pharmacy) Maintenance 10%; $20 max 30%; $15 min/$100 max 10%+; $15 min/$100 max* N/A 30-day supply (any network retail pharmacy, up to 3 fills)** 10%; $20 max 30%; $15 min/$100 max 10%+; $15 min/$100 max* 30%; $15 min/$100 max 30-day supply (any network retail pharmacy, after 3 fills)** 20%; $40 max 60%; $30 min/$150 max 20%+; $30 min/$200 max* N/A 90-day supply (CVS pharmacies or CVS Mail Service) 10%; $40 max 20%; $20 min/$100 max 10%+; $30 min/$200 max* 30%; $20 min/$100 max Annual Out-of-Pocket Maximum $2,000 individual/$6,000 family* 6
7 Illustrative claim examples (family coverage) Prescription drug claims Non-HDHP Plans Drug Name Type of Drug Maintenance Day Supply Gross Cost Patient Cost Net Plan Cost Amoxicillin Cap 500MG Generic No 10 $3 $3 $0 Viagra Tab 50MG Brand No 25 $400 $100 $300 Enbrel Syringe 50MG/ML Specialty N/A 28 $8,000 $100 $7,900 HDHP Plan* Drug Name Type of Drug Maintenanc e Day Supply Gross Cost HSA Patient Cost Net Plan Cost Amoxicillin Cap 500MG Generic No 10 $3 $3 $0 $0 Viagra Tab 50MG Brand No 25 $400 $400 $0 $0 Enbrel Syringe 50MG/ML Specialty N/A 28 $8,000 $2,000 $1,500 $4,500 Example assumes this is the first fill in the new plan year. Next fill will be at 10% only unless max oop has already been met. 7
8 Aetna HDHP with HSA High Deductible Health Plan Allows colleague to open a Health Savings Account (HSA) Colleague pays full cost of care including prescriptions until deductible is met. If covering one or more dependents, the family deductible must be met first. (Preventive care is covered at 100%) Choose any provider - In-network deductible is lower - Penn Providers are in network Penn will Contribute $1000/$2000 for the 2018/2019 Plan Year to Health Savings Account to assist with cost of Deductible. Contribution amount will be reviewed each year. Members are not eligible to participate in the Health Care Flexible Spending Account Visiting Scholars and members of Locals 54,115 and 590 are not eligible International Travel - covered for medically necessary Emergency and Urgent Care services only MERCER 8
9 High Deductible Health Plan 9
10 HSA Rules: You are not allowed to be enrolled in any other health coverage plan, including Medicare, or union plans ( i,e. no secondary coverage permitted under spouse) Money must be in HSA account to receive reimbursement You may change your HSA pre-tax contribution amounts anytime during the year. You can not be enrolled in Penn s Health Care Flexible Spending Account Your spouse can not have a full Flexible Spending Account You are not permitted to use your HSA dollars on dependents between the Ages 24-26, or on domestic partners. Contributions can be made to your account post-tax Catch up Contributions are permitted age 55+ (except if Medicare enrolled) Portability- You can take the money in your account with you if you leave Penn. You, not Penn, own the account Qualified and non-qualified Withdrawals Customer Identification Process for HSA (Section 326 of USA Patriot Act) Pre tax limits are $3450 (individual) and $6850(family) if you hit the pre tax max in any year you must stay in the HDHP for the next plan year. This includes Penn s contribution. 1 10
11 Medical Rates (no increase) FULL-TIME WEEKLY PAID (per pay period) FULL-TIME MONTHLY PAID (per pay period) Employee Child(ren) Spouse/ Partner Family Employee Child(ren) Spouse/Partner Family PennCare/ Personal Choice $47.08 $79.15 $ $ $ $ $ $ Aetna Choice POS II $32.31 $54.69 $83.08 $ $ $ $ $ Keystone/ AmeriHealth HMO $22.15 $37.38 $59.31 $73.38 $96.00 $ $ $ Aetna HDHP $21.00 $35.31 $54.92 $ $91.00 $ $ $ MERCER 11
12 Dental Plans 12
13 Dental Plans Rates: WEEKLY PAID (per pay period) MONTHLY PAID (per pay period) Employee Child(ren) Spouse/ Partner Family Employee Child(ren) Spouse/Partner Employee + Family Penn Family Plan $8.77 $19.41 $17.21 $27.38 $38.02 $84.10 $74.59 $ MetLife Dental $6.31 $13.89 $12.60 $18.93 $27.34 $60.18 $54.62 $82.03 MERCER 10
14 Vision Plans Networks Davis Vision 1. Scheie Eye top tier 2. Davis Vision Network 3. Out-of-Network VSP 1. Choice Network includes Scheie Eye 2. Out-of-Network Deductible None None Copay Based on treatment type Based on treatment type Frames Laser Vision Correction Disposable Contact Lenses 1. $100 retail, $0 from collection 2. $65 retail, $0 from collection 3. Reimbursed up to $30 1. For discounts, call Davis Vision or Scheie Eye 1. $80 allowance 2. $75 allowance 3. Reimbursed up to $75 1. $150 retail + 20% off excess 2. $150 retail 3. Reimbursed up to $70 1. For discounts, call VSP or Scheie Eye 1. $150 allowance 2. $150 allowance 3. Reimbursed up to $150 14
15 Vision Plans Rates: WEEKLY PAID (per pay period) MONTHLY PAID (per pay period) Employee Child(ren) Spouse/ Partner Family Employee Child(ren) Spouse/Partner Employee + Family Davis Vision Plan $1.09 $1.77 $2.36 $3.00 $4.73 $7.65 $10.22 $13.01 VSP Plan $1.57 $2.56 $3.40 $4.34 $6.82 $11.09 $14.74 $18.79 MERCER 12
16 Flexible Spending Accounts Health Care Spending Account Pre tax account where you deduct a small amount from your weekly pay to use to reimburse yourself for medical expenses that you are responsible for. $2,650 Annual Limit Full Time Employees For current plan year, claims must be incurred by June 30, 2018; Submitted by September 30, 2019 Can carry over up to $500 (available in Nov), unused amounts over $500 you lose Debit Card for both current and carry over funds- but must save receipts in case substantiation is required! Cannot change goal amount outside window (Open Enrollment only or qualifying event) Save your receipts! 16
17 Flexible Spending Accounts Dependent Care Spending Account Pre-tax account where you set aside a small amount weekly/monthly to reimburse yourself for daycare or other child care expenses for dependent child(ren) up to age 13 $5,000 calendar-year limit ($1,800 for Highly Compensated employees) For current year, claims must be incurred by September 15, 2018 and submitted by September 30, 2018; Use it or lose it IRS rule Cannot change goal amount outside window (Open Enrollment only or qualifying event) 17
18 Find qualified doctors Expedite appointments Provide cost estimates Straighten out claims Locate eldercare services Health Advocate Navigate insurance plan Explain conditions Assist with the transfer of medical records Secure second opinions
19 StayWell Wellness Partner and Portal Penn Wellness Campaign Biometric Screenings Earn Points towards Cash Incentives Health Assessment Health Coaches Smoking Cessation Online Wellness Programs Wellness information Tools penn.staywell.com 19
20 Changing Your Coverage Open Enrollment - Annual opportunity to make changes - April 23-May 4 - Changes effective July 1 After Open Enrollment??? Life or status change events - Examples: marriage, divorce (up to 60 days), birth of a child, relocating out of your insurance carriers service area, a move from full-time to part-time status - Must make changes within 30 days of date of event 20
21 Illustrative claim examples (family coverage) PCP sick visit PCP Claim (one individual) Billed Allowed $200 $150 Amount owed to providers: HDHP Aetna POS II Premium PennCare PPO HMO $150 $150 $150 $150 Plan pays: $0 $120 $130 $125 Deductible: $150 $0 $0 $0 Copay: $0 $30 $20 $25 Coinsurance: $0 $0 $0 $0 Total: $150 $30 $20 $25 HSA Pays $150 $0 $0 $0 Example assumes this is the first claim in the new plan year. Patient Pays: $0 $30 $20 $25 21
22 Illustrative claim examples (family coverage) Emergency Room (without hospital admission) ER Claim (one individual) Billed Allowed $8,000 $4,000 Amount owed to providers: HDHP Aetna POS II Premium PennCare PPO HMO $4,000 $4,000 $4,000 $4,000 Plan pays: $900 $3,850 $3,900 $3,850 Deductible: $3,000 $0 $0 $0 Copay: $0 $150 $100 $150 Coinsurance: $100 $0 $0 $0 Total: $3,100 $150 $100 $150 Example assumes this is the first claim in the new plan year. HSA Pays : $2,000 $0 $0 $0 Patient Pays: $1,100 $150 $100 $150 22
23 Illustrative claim examples Family coverage High utilizer Claims incurred in the following order: Allowed Charges Maternity $24,500 Well baby visit $150 Sick PCP visit $150 Generic drug $3 ER visit w/out admission $4,000 TOTAL $28,803 Employee OOP Cost HDHP Choice POS II PennCare PPO HMO Maternity $5,150 $2,400 $2,000 $2,400 Well baby visit $0 $0 $0 $0 Sick PCP visit $150 $0 $0 $0 Generic drug $3 $3 $3 $3 ER visit w/out admission $400 $0 $0 $0 Utilize HSA dollars ($2,000) $2,000 N/A N/A N/A Subtotal $3,703 $2,403 $2,003 $2,403 Annual Payroll Deduction $3,576 $5,364 $7,596 $3,816 TOTAL OOP $7,279 $7,767 $9,599 $6,219 = Combined Medical/Rx OOP Maximum Hit (100% coverage there after) = Medical OOP Maximum Hit (100% coverage there after medical only) 23
24 Illustrative claim examples Single coverage High utilizer Claims incurred in the following order: Allowed Charges Specialty Rx (1/month) $96,000 Preventive PCP visit (1/year) $150 Sick/Non-Preventive PCP visit (4/year) $600 ER visit with admission $18,000 TOTAL $114,750 Employee OOP Cost HDHP Choice POS II PennCare PPO HMO Specialty Rx (1/month) $3,000 $1,200 $1,200 $1,200 Preventive PCP visit (1/year) Sick/Non-Preventive PCP visit (4/year) $0 $0 $0 $0 $0 $120 $80 $100 ER visit with admission $0 $1,080 $920 $1,100 Utilize HSA dollars ($1,000) $1,000 N/A N/A N/A Subtotal $2,000 $2,400 $2,200 $2,400 Annual Payroll Deduction $1,092 $1,680 $2,448 $1,152 TOTAL OOP $3,092 $4,080 $4,648 $3,552 = Combined Medical/Rx OOP Maximum Hit (100% coverage there after) = Medical OOP Maximum Hit (100% coverage there after medical only) 24
25 Illustrative claim examples Single coverage Low utilizer Claims incurred in the following order: Allowed Charges Preventive PCP visit (1/year) $150 Sick/Non-Preventive PCP visit (1/year) $150 Generic drug $3 TOTAL $303 Employee OOP Cost HDHP Choice POS II PennCare PPO HMO Preventive PCP visit (1/year) Sick/Non-Preventive PCP visit (1/year) $0 $0 $0 $0 $150 $30 $20 $25 Generic drug $3 $3 $3 $3 Utilize HSA dollars ($1000) $153 N/A N/A N/A Subtotal $0 $33 $23 $28 Annual Payroll Deduction $1,092 $1,680 $2,448 $1,152 TOTAL OOP $1,092 $1,713 $2,471 $1,180 = Combined Medical/Rx OOP Maximum Hit (100% coverage there after) = Medical OOP Maximum Hit (100% coverage there after medical only) 25
26 Penn Benefits Center PENN-BEN Monday-Friday 8:00am-6:00pm EST For information on your benefit packet, benefit plans, general questions and to enroll Visit: For general employment and HR questions call: Penn Solutions Center
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